The present invention relates to sutures for use in laparoscopic/pelviscopic surgery, and more particularly to the provision of sutures which are more easily tied and secured in a body cavity using graspers extending through trocars in the body wall.
The present invention relates to suture tying or suture fastening in laparoscopic/pelviscopic surgery which is a rapidly growing field of surgery in this and other countries. Typically, a patient is anesthetized and placed on a surgery table for surgery. An initial very small opening, perhaps 12 mm in diameter, is made in the body wall for insertion of a scope or optic probe which will facilitate viewing inside the body cavity. In the case of the abdominal cavity, for instance, the cavity may be expanded by an insufflation process using carbon dioxide under pressure. This type of surgery is beginning to be well known as Minimally Invasive Surgery (MIS) or Less Invasive Surgery (LIS).
One of the well known problems with MIS or LIS is that the use of sutures is a very difficult task for many surgeons. The surgeon has to be able to tie a suture inside the body cavity using graspers which extend through trocars in the body wall. The surgeon has to do this tying while viewing the suture and the body tissue with which the suture is used on a television camera picking up the image through the scope or optic probe.
Many MIS or LIS procedures are accomplished today using very expensive disposable clip guns which apply titanium clips to various body conduits such as the cystic duct, artery or other blood vessel. Some of these clip guns may cost the hospital, for instance, more than $200 and up to as much as $280. These clip guns are so frail and intricate in design and made from plastic that they cannot be easily sterilized to be reusable after a surgery. They are simply loaded with a supply of, for instance, twenty clips to be used in a single MIS or LIS procedure and then disposed of with all of the other disposable equipment used in the procedure.
It is believed that more surgeons would use low-cost sutures and not use the more expensive titanium clips requiring the disposable clip guns in MIS or LIS if suture ligation was made easier inside the body cavity. In addition, many surgeons prefer the security of sutures over metal clips.
It is an object of the present invention, therefore, to provide a suture for use in MIS or LIS surgery and tying intracorporeally using graspers which extend through trocars in the body wall, the suture comprising a length of suture material suitable for fastening (approximating) body tissue within the body cavity. The suture length, of course, has opposite end portions. A gripping means is attached to at least one of the end portions of the suture length, the gripping means being formed and shaped to facilitate engagement and movement by the graspers conventionally used in MIS or LIS surgery to facilitate tying a knot in the suture length.
In one embodiment of the present invention, a needle will be attached (swedged on) to the other end portion of the suture length to facilitate penetration of the suture length through tissue, whereby the opposite end portions can then be tied by manipulating the gripping means and the needle.
Another object of the present invention is to provide such a gripping means which comprises a soft, sponge-like body attached to the suture length opposite end. This body may be generally elongated in the direction of the suture length to have a proximal end attached to an end portion of the length and a distal end extending away from the length. In another embodiment of the present invention, the body may be a wax-like or deformable material enclosing the suture end portion to be gripped by a grasper. This wax-like or deformable material may be made from a material which will be absorbable in the body cavity. The body may be impregnated with any suitable pharmaceutical material such as, for instance, an antibiotic agent.
In accordance with the present invention, the gripping means body is preferably of a diameter small enough to be placed through the body wall by passing through a cannula having an internal diameter in the range of 5 mm to 12 mm.
Another object of the present invention is to provide a ligation suture for use in tying off a body conduit such as the cystic duct, artery or other blood vessel inside a body cavity during MIS or LIS surgery procedures using graspers extending through trocars in the body wall, the suture comprising a length of suture material sufficiently long to accommodate the circumference of the targeted conduit and the knot to be tied, the length having opposite end portions. A gripping means is attached to each length end portion, the gripping means being formed to have a size larger in transverse cross section than the suture length cross section to facilitate gripping and controlled movement with the graspers.
The gripping means may comprise a body formed from a material more rigid than the suture material, and may be formed as an elongated body attached to the suture length. The elongated body may have a length greater than about three times its transverse cross sectional dimension. In some cases, the body may be shaped as a slightly curved paddle in the elongated direction for use in moving tissue deflecting an organ or encircling a structure to be ligated.
Further, the gripping means may be made of material or coated with material which is colored to be distinctive in the scope view or on the video screen.
Other objects and features of the present invention will become apparent as this description progresses.